BACKGROUND: Overlap syndrome is a large group of condition that manifests with symptoms from two or more autoimmune conditions and satisfies the diagnostic criteria of at least two connective tissue diseases in the same patient. This condition might be unrecognized by the primary care physician and underreported.
CASE: A 30-year-old female had a 10-week history of non-pruritic erythematous macules on her face that gradually spread to her trunk, and upper extremities which progressed to hyperpigmented macules and tightening of the skin. There was note of hair loss, anemia, ulcerating wounds on distal extremities and finger tips. She then developed generalized body weakness and easy fatigability. Physical and laboratory examinations were consistent with SLE and scleroderma. 2D-echocardiogram showed a large pericardial effusion and pulmonary hypertension. She was treated with prednisone and azathioprine which in less than a week, diminished significantly the pericardial effusion. Patient also complained of a few day history of unilateral blurring of vision which turned out to be central retinal artery occlusion.
CONCLUSION: Overlap syndrome is a disease entity to consider in patients with multiple symptoms that cannot be classified into one connective tissue disease. Treatment of this disease should be individualized and based on the connective tissue diseases involved.

Human ; Female ; Adult ; Prednisone ; Azathioprine ; Pericardial Effusion ; Connective Tissue Diseases ; Torso ; Extremities ; Hypertension, Pulmonary ; Alopecia ; Anemia ; Retinal Artery Occlusion

Introduction: Type 2 diabetes mellitus (DM) is one of the leading non-communicable causes of death in the Philippines with a prevalence of 5.4% and its pathogenesis includes insulin resistance correlated with excess weight and BMI. Asian-based studies have shown that serum C-peptide is strongly associated with newly diagnosed diabetes and has a linear increasing trend with BMI, hence, this study aimed to determine the correlation of body mass index (BMI) with fasting C-peptide levels in Filipino patients with newly diagnosed type 2 DM. Also, to determine the correlation of fasting C-peptide, markers of insulin secretion and sensitivity (Homeostasis Model Assessment of beta cell function and insulin resistance: HOMA-IR, HOMA-B) with other metabolic parameters in newly diagnosed diabetics: waist circumference, HbA1C, fasting blood sugar (FBS), lipid profile. Methods: This cross-sectional study included 35 treatment naïve, newly diagnosed type 2 DM Filipino patients evaluated with anthropometric measurements, fasting C-peptide, and other metabolic parameters. The correlations among fasting C-peptide, BMI, waist circumference, FBS, HbA1c, lipid profile, HOMA-IR, and HOMA-B were determined using Pearson correlation. Results: A significant positive relationship were observed between BMI and HOMA-IR(r=0.335); C-peptide and waist circumference (r=0.363); C-peptide and HOMA-B(r=0.357); HOMA-IR and C-peptide (r=0.892); HOMA-IR and waist circumference (r=0.438); HOMA-IR and triglycerides (r=0.543). HOMA-B was negatively correlated with FBS and HbA1C (r=- 0.771, and r=-0.641, respectively). No correlation was seen between BMI and C-peptide (p=0.61). Conclusion Body mass index (BMI) is not correlated with fasting C-peptide levels in newly diagnosed type 2 DM Filipino patients. The positive relationship between C-peptide, waist circumference, and HOMA-IR merits further evaluation with larger studies.
C-Peptide ; Diabetes Mellitus, Type 2 ; Body Mass Index ; Insulin Resistance

A lateral neck mass can be the initial presentation of a papillary thyroid carcinoma. A 24-year-old female presented with a 2.0 x 2.0 cm, non-erythematous, non-tender, right lateral neck mass. A neck ultrasound showed an enlarged right jugulodigastric (Level II) lymph node and a normal-sized thyroid gland exhibiting mild parenchymal disease with no nodules. Positron emission tomography-computed tomography scan (PET-CT) showed an enlarged intensely fluorodeoxyglucose (FDG)-avid right level III lymph node, which may be primary versus metastatic. Fine-needle aspiration biopsy (FNAB) of the lymph node showed the presence of atypical cells that are highly suspicious for metastatic carcinoma. A cervical lymph node excision biopsy was performed and histopathology showed metastatic papillary thyroid carcinoma. The patient underwent total thyroidectomy with neck dissection. The final histopathologic examination of the thyroid gland revealed chronic lymphocytic thyroiditis with the lymph nodes negative for metastasis. She eventually underwent radioactive iodine ablation (RAI) with a dose of 30mCi. Post-RAI whole-body scan showed functioning thyroid tissue remnants with no distant metastasis. This case adds to the limited data that ectopic thyroid carcinoma can be present in patients who initially present with neck masses.
Thyroid Gland ; Carcinoma, Papillary

BACKGROUND: Entamoeba histolytica is an important etiologic agent of diarrhea. Globally, it is estimated to infect 40 to 50 million people and cause 40,000 to 100,000 deaths per year. Metronidazole is effective but can cause adverse reactions in certain individuals. In search of alternatives, traditional medicinal plants are being studied. Several plants in Family Simaroubaceae have shown anti-amoebic activity. Quassia amara, a member of this family has not been tested.
OBJECTIVE: To determine the effect of Q. amara crude extract on Entamoeba histolytica in vitro.
METHODS: Initial testing of 104 µg/ml ethanolic bark extract was performed. Counts were made after 72 hours. Three trials in triplicates were performed.
Nine (9) dilutions of extract were then tested (18.8 to 5,00 µg/ml). Test tubes were checked for viable amoeba after 24-hour and 72-hour incubation. Minimum inhibitory concentrations (MIC) were determined for the two incubation periods. At least two trials in triplicates for each dilution were performed. metronidazole served as positive control.
RESULTS: At 104 µg/ml incubated for 72 hours, no viable amoeba was obtained and counted. The MIC after 24 hours was 5,000 µg/ml, while the MIC at 72 hours was 37.5 µg/ml.
CONCLUSION: Q. amara crude extract has inhibitory effects on E. histolycain vitro.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Child Preschool ; Infant ; Infant Newborn ; Quassia ; Metronidazole ; Entamoeba Histolytica ; Plants, Medicinal ; Amoeba ; Simaroubaceae ; Microbial Sensitivity Tests ; Diarrhea